---
title: "Dental pain"
url: "https://acuiq.com/wiki/evidence/dental-pain"
updated: 2026-10-14
last_verified: 2026-10-14
license: CC-BY-4.0
license_url: "https://creativecommons.org/licenses/by/4.0/"
section: "evidence"
basis: "Modern research"
audience: "Anyone"
published: "2026-10-14"
reading_minutes: 10
sources: 12
---

# Dental pain

_What three systematic reviews, a Cochrane review of the gag reflex, five trials and two dental pain guidelines report on acupuncture and acupressure for toothache, pain after wisdom tooth removal and related dental uses._

Dental pain covers toothache from a decayed or inflamed tooth, pain during dental treatment and pain in the hours and days after it. The commonest procedure in trials of acupuncture for dental pain is removal of a lower wisdom tooth, or third molar, according to the [2023 review](https://doi.org/10.1016/j.jdsr.2023.02.005) by Müller and colleagues. Reviews that pool these trials report less pain with acupuncture than with sham, on small trials at unclear risk of bias; the two largest sham-controlled trials after wisdom tooth removal found no difference. The [American Dental Association guideline](https://doi.org/10.1016/j.adaj.2023.10.009) of 2024 treats painkillers for toothache as a stopgap until a dentist can treat the tooth itself, and covers drugs only. Pain in the jaw joint and chewing muscles is a separate condition, reported in [Temporomandibular disorders](/wiki/evidence/temporomandibular-disorders).

## No Cochrane review of dental pain

Cochrane has not published a review of acupuncture for toothache or for pain after tooth extraction. Its review of the [gag reflex during dental treatment](https://doi.org/10.1002/14651858.CD011116.pub3), last updated in 2019, includes acupuncture and acupressure and is reported below.

## Reviews of acute dental pain

**Müller and colleagues, 2023.** This [review](https://doi.org/10.1016/j.jdsr.2023.02.005) from the University of Freiburg, published in the Japanese Dental Science Review, searched MEDLINE, the Cochrane Library and Web of Science to the end of 2020 for controlled trials of needle acupuncture or electroacupuncture in adults with acute dental pain; acupressure was excluded, and only papers in English, German, French or Spanish were read. It included 23 studies, 21 of them randomised. Third molar removal was the most common procedure, and two trials treated pain from root canal work. The review pooled three comparisons separately:

- Against sham acupuncture, pain after treatment was lower with acupuncture, across 202 people (pooled effect −0.77, 95% CI −1.52 to −0.03). The trials disagreed widely with one another (I² 83%, where higher values mean more inconsistency).
- Against local anaesthetic, pain during treatment did not differ, across 269 people.
- With and without acupuncture, the number of painkiller tablets taken afterwards did not differ, across 247 people (mean difference −0.32, 95% CI −2.09 to 1.45).

None of the 21 randomised trials reached an overall rating of low risk of bias, none had a published protocol, and no corresponding author answered the reviewers’ questions about methods. In two 1976 trials by Brandwein and colleagues that the review included, lidocaine gave more complete anaesthesia during drilling than acupuncture alone. The authors describe a potential role for acupuncture, limited by methodological flaws, and ask for high-quality trials. The review did not grade the certainty of its evidence.

**Alves and colleagues, 2025.** This [review](https://doi.org/10.1007/s10006-025-01415-6) in Oral and Maxillofacial Surgery, from Brazil, screened 717 records and included 6 trials of acupuncture after lower third molar surgery, assessing bias with the Cochrane RoB 2 tool. Pain scores were lower in the acupuncture groups at 2, 18, 24, 48 and 72 hours. The authors concluded that, given the heterogeneity of the trials and the low level of evidence, it is not possible to say whether acupuncture is a viable method of pain control after the operation. The published abstract does not break the six trials down by control.

**Ernst and Pittler, 1998.** This [review](https://doi.org/10.1038/sj.bdj.4809654) in the British Dental Journal searched Medline, Embase, CISCOM and the Cochrane Library, found 16 controlled trials and scored their quality on the Jadad scale. Most of the trials implied that acupuncture had an analgesic effect. Ernst and Pittler concluded that acupuncture can alleviate dental pain, and asked later trials to define the best technique and compare it with conventional painkillers.

## Landmark trials

- **Needle against non-insertion placebo, 1999.** A double-blind [trial](https://doi.org/10.1001/archotol.125.5.567) at the University of Maryland dental school, by Lao and colleagues, randomised 39 healthy adults aged 18 to 40 after oral surgery to acupuncture or a placebo procedure in which no needle entered the skin. The Müller review lists the points as [`LI04`](/points/li04) (Hegu), [`ST06`](/points/st06) (Jiache), [`ST07`](/points/st07) (Xiaguan) and [`TB17`](/points/tb17) (Yifeng). People given acupuncture went 173 minutes without pain on average, against 94 with placebo, waited 242 minutes before asking for rescue medication, against 166, and took 1.1 tablets against 1.65. Total pain relief did not differ. Nearly half or more of the participants were unsure or wrong about which treatment they had received, and the authors judged the placebo a valid control. An earlier pilot of 19 people by the same group reported a similar difference.
- **Acupuncture against ibuprofen, 2017.** The largest trial of pain after treatment in the Müller review, by Murugesan and colleagues, gave 157 people having root canal work acupuncture at `LI04`, `ST06`, `ST07` and `TB17` with a placebo pill, sham acupuncture with a placebo pill, or sham acupuncture with ibuprofen. Pain was lower with real acupuncture than in both other groups from 15 minutes to 48 hours, and the sham groups did not differ from each other.
- **Ear electroacupuncture, 2007.** A double-blind [trial](https://doi.org/10.1213/01.ane.0000253233.51490.dd) by Michalek-Sauberer and colleagues randomised 149 people having one lower wisdom tooth removed under local anaesthetic to needles at three ear points (tooth, Shen men and mouth) with electrical stimulation, the same needles without it, or metal plates with no needle and no current, worn for 48 hours. Neither the share of time with moderate or worse pain nor the number of paracetamol tablets taken differed between the three groups. [Ear acupuncture](/wiki/techniques/ear-acupuncture) describes the method.
- **Expectation and blinding, 2013.** A [trial](https://doi.org/10.1016/j.pain.2013.05.008) by Vase and colleagues gave 101 people with pain of at least 3 out of 10 after third molar surgery 30 minutes of acupuncture, placebo acupuncture with a needle designed to allow double-blinding, or no treatment. Placebo acupuncture had a large effect compared with no treatment, and real acupuncture had no effect beyond it. People who believed they had received real acupuncture reported less pain, whichever they had received, and the pain they expected accounted for up to 70% of the variation in the pain they reported. [Sham acupuncture](/wiki/research/sham-acupuncture) sets out what such controls can rule out.

## Gag reflex

The [Cochrane review](https://doi.org/10.1002/14651858.CD011116.pub3) by Eachempati and colleagues, updated in November 2019 with searches to March 2019, looked for trials of any drug or non-drug treatment for gagging that interferes with dental treatment. It found 4 trials, with 328 participants including 65 children aged 4 or older, and every one tested stimulation of [`PC06`](/points/pc06) (Neiguan) on the inner forearm, against a sham. All evidence was rated very low certainty.

| Treatment | Procedure completed | Less gagging |
| --- | --- | --- |
| Acupuncture | RR 1.78 (1.05 to 3.01); 2 trials, 59 people | RR 2.57 (1.12 to 5.89); 1 trial, 26 people |
| Acupuncture with sedation | No difference; 1 trial, 34 people |  |
| Acupressure with a device | RR 2.63 (1.33 to 5.18); 1 trial, 34 people | RR 3.94 (1.63 to 9.53); 1 trial, 34 people |
| Thumb acupressure, wristband, or device with sedation | No clear difference | No clear difference |

A risk ratio (RR) above 1 favours the treatment, and the figures in brackets are 95% confidence intervals. Laser at the same point also showed less gagging than a dummy laser in two small trials. The authors concluded that the evidence was insufficient to say whether acupuncture, acupressure or laser at the point brings any benefit, and found no trial of any other treatment for gagging.

## Dental anxiety

A [2026 systematic review](https://doi.org/10.3389/phrs.2026.1609316) by Wawrzyniak and colleagues of non-drug treatments for dental anxiety included 126 studies published from 1971 to 2024 and graded them with GRADE. It reports that acupressure studies found fewer injections needed during prosthetic work and lower anxiety in children, and calls that evidence limited by small samples and inconsistent methods. Its moderate-certainty findings were for aromatherapy, laser-based treatments and audiovisual distraction. Two trials tested ear acupuncture before dental treatment:

- A [2007 trial](https://doi.org/10.1213/01.ane.0000242531.12722.fd) by Karst and colleagues randomised 67 people having teeth extracted to ear acupuncture, placebo acupuncture, midazolam sprayed into the nose, or no treatment. At 30 minutes the ear acupuncture and midazolam groups were less anxious than the placebo acupuncture group, and the dentist rated both groups as more cooperative.
- A [2012 trial](https://doi.org/10.1007/s00784-011-0662-4) by Michalek-Sauberer and colleagues randomised 182 people to needles at three ear points used for anxiety, needles at three unrelated ear points, or no needles. Anxiety scores on the Spielberger inventory fell from 54.7 to 46.9 with the anxiety points and from 51.9 to 48.4 with the unrelated points, and rose from 51.0 to 54.0 without needles.

## What guidelines say

The [American Dental Association guideline](https://doi.org/10.1016/j.adaj.2023.10.009) for adolescents, adults and older adults, by Carrasco-Labra and colleagues, was published in February 2024 and covers pain after tooth extraction and the temporary management of toothache when dental treatment is not immediately available. Its scope is drugs: the panel ran four systematic reviews of painkillers, local anaesthetics and corticosteroids and graded them with GRADE. It suggests an anti-inflammatory such as ibuprofen, alone or with paracetamol, as first-line treatment, a conditional recommendation on low certainty evidence, and reserves opioids for when that fails. It does not address acupuncture. No later version is indexed in Europe PMC as of October 2026.

The [Indian Society of Periodontology recommendations](https://doi.org/10.4103/jisp.jisp_131_26) of January 2026, drawn up by a panel of 19 experts from a literature review and consensus discussion, list acupuncture with breathing exercises, massage, meditation and relaxation among alternative therapies for dental pain, and with cold therapy, low-level laser and behavioural techniques among non-drug adjuncts drawing interest for mild discomfort after treatment. They make no specific recommendation on it.

## What the reviews could not settle

Whether needling adds anything beyond a convincing sham is open. The Müller review’s pooled result against sham rests on 202 people and inconsistent trials, while the Michalek-Sauberer and Vase trials, the largest sham-controlled trials after wisdom tooth removal in that review, found no difference, and Vase’s found that expectation tracked pain. Trials measured pain over hours to days, and few compared acupuncture with the anti-inflammatory painkillers the ADA recommends first. Almost every trial treated pain caused by a dental procedure rather than toothache from an untreated tooth. For the gag reflex every result is very low certainty, and for dental anxiety the trials are few and small. [Postoperative pain](/wiki/evidence/postoperative-pain) reports the trials after other kinds of surgery.

AcuiQ’s [toothache](/symptoms/toothache), [dental pain](/symptoms/dental-pain) and [gag reflex](/symptoms/gag-reflex) pages list the protocols individual studies prescribed, each with its citation.

### Sources

1. Eachempati P, Kumbargere Nagraj S, Kiran Kumar Krishanappa S, George RP, Soe HHK, Karanth L, Management of gag reflex for patients undergoing dental treatment, Cochrane Database of Systematic Reviews 2019 — https://doi.org/10.1002/14651858.CD011116.pub3
2. Müller M, Schmucker C, Naumann J, Schlueter N, Huber R, Lederer AK, Acupuncture in management of acute dental pain: a systematic review and meta-analysis, Japanese Dental Science Review 2023 — https://doi.org/10.1016/j.jdsr.2023.02.005
3. Alves KC, da Hora Sales PH, de Barros Silva PG, Mousinho KC, Can acupuncture be a viable method for pain control after lower third molar removal? A systematic review with meta-analysis, Oral and Maxillofacial Surgery 2025 — https://doi.org/10.1007/s10006-025-01415-6
4. Ernst E, Pittler MH, The effectiveness of acupuncture in treating acute dental pain: a systematic review, British Dental Journal 1998 — https://doi.org/10.1038/sj.bdj.4809654
5. Lao L, Bergman S, Hamilton GR, Langenberg P, Berman B, Evaluation of acupuncture for pain control after oral surgery: a placebo-controlled trial, Archives of Otolaryngology: Head and Neck Surgery 1999 — https://doi.org/10.1001/archotol.125.5.567
6. Michalek-Sauberer A, Heinzl H, Sator-Katzenschlager SM, Monov G, Knolle E, Kress HG, Perioperative auricular electroacupuncture has no effect on pain and analgesic consumption after third molar tooth extraction, Anesthesia and Analgesia 2007 — https://doi.org/10.1213/01.ane.0000253233.51490.dd
7. Vase L, Baram S, Takakura N, Yajima H, Takayama M, Kaptchuk TJ, et al., Specifying the nonspecific components of acupuncture analgesia, Pain 2013 — https://doi.org/10.1016/j.pain.2013.05.008
8. Wawrzyniak A, Sadowska N, Pawlak-Mojsiewicz M, et al., Non-pharmacological and physical strategies for managing dental anxiety: a systematic review with implications for dental education, Public Health Reviews 2026 — https://doi.org/10.3389/phrs.2026.1609316
9. Karst M, Winterhalter M, Münte S, et al., Auricular acupuncture for dental anxiety: a randomized controlled trial, Anesthesia and Analgesia 2007 — https://doi.org/10.1213/01.ane.0000242531.12722.fd
10. Michalek-Sauberer A, Gusenleitner E, Gleiss A, Tepper G, Deusch E, Auricular acupuncture effectively reduces state anxiety before dental treatment: a randomised controlled trial, Clinical Oral Investigations 2012 — https://doi.org/10.1007/s00784-011-0662-4
11. Carrasco-Labra A, Polk DE, Urquhart O, et al., Evidence-based clinical practice guideline for the pharmacologic management of acute dental pain in adolescents, adults, and older adults, Journal of the American Dental Association 2024 — https://doi.org/10.1016/j.adaj.2023.10.009
12. Grover V, Kumar A, Satpathy A, et al., Indian Society of Periodontology Good Clinical Practice Recommendations for dental pain management and use of analgesics, Journal of Indian Society of Periodontology 2026 — https://doi.org/10.4103/jisp.jisp_131_26